As a dad, I totally appreciate the Instagram photos of 4-month-old Ace Wells Tucker sitting on the potty. The little dude — son of Todd Tucker and Real Housewives of Atlanta’s Kandi Burruss — is adorable.
But as a pediatric urologist, I cringe at those pictures, because potty training babies is risky business.
I know early toilet training is popular. This week, too, supermodel Coco Rocha told People she’s training her 13-month-old daughter, Ioni, and Kim Kardashian recently told the magazine her daughter North is “so smart” because, at 19 months, she was already using the toilet.
Here’s the problem: Children toilet trained before age 2 are at high risk of later developing bladder and bowel problems.
In fact, our research at Wake Forest University has found children trained earlier than 24 months have triple the risk of having chronic daytime accidents compared to kids trained between 2 and 3.
In my clinic, the kids who have developed the most stressful and significant problems — daily poop and pee accidents, extended bedwetting — are typically those who trained earliest.
It’s not that babies and toddlers can’t pee or poop on the toilet. Sure they can. The problem is, children this young don’t have the judgment to respond to their bodies’ urges in a timely manner. So, they get in the habit of holding their poop and pee.
Eventually stool piles up, forming a large, hard mass that stretches the rectum (think: rat in a snake’s belly) and presses against and aggravates the bladder. Holding pee thickens and further irritates the bladder. Eventually, the bladder starts hiccuping and emptying without notice.
Overnight, the squished bladder can’t hold enough urine, so these kids routinely wet the bed. Poop accidents are a risk, too. An overstretched rectum loses tone and sensation, so poop may simply fall out — without the child even noticing.
All this may take place two or three years down the line, so when celebs boast that their toddler is potty trained — well, there may be an epilogue we don’t hear about. Many of my patients didn’t start having accidents until kindergarten.
Of course, not every child trained as a baby or toddler is destined for dysfunctional elimination! But in our study, published in Research and Reports in Urology, 60 percent of the children trained before age 2 presented with accidents well after being potty trained.
Kandi Burruss says she doesn’t expect Ace to be fully trained any time soon, and she’s only placing him on the toilet to “get used to the concept early.” I’m glad her expectations are low. Still, sitting on the toilet in no way benefits babies and may speed up a process that should not be accelerated.
I have many patients who, according to their moms, “practically potty trained themselves” at 18 months, without any parental pressure. I believe these kids were not forced or bribed into training early; nonetheless, they wound up in my clinic with pretty severe, and entirely preventable, toileting problems.
Maybe little Ace and Ioni and North will ditch their diapers early and never look back. Or, maybe they’ll end up one day in a clinic like mine. I have no idea. But I do know this: Potty problems are epidemic in the developed world, driven by our rush to potty train, our highly processed diet, and our restrictive school bathroom policies.
When famous people post about their potty prodigies on social media, they foster our culture of unrealistic expectations. Many parents who read about potty-trained toddlers feel like failures or slackers and, in turn, ramp up expectations for their own children.
Parents who train their children early — to meet preschool deadlines, to save landfills from diapers, or because they think it’s cool to have a potty-trained baby — should know what can happen to a child's insides.
Based on my experience and research findings, I encourage parents to delay potty training until a child is around age 3. But no matter what the child's age, parents must vigilantly monitor the child for signs of constipation, which are often subtle and not widely known. (The top two signs are extra-large poops and hard poops, shaped like pellets or logs.) A child can poop daily and still be severely constipated!
What's also critical is that the child, not Mom or Dad, is leading the way.
Steve Hodges, M.D., is an associate professor of pediatric urology at Wake Forest University School of Medicine and co-author, with Suzanne Schlosberg, of It's No Accident and Bedwetting and Accidents Aren't Your Fault.